Restorative Techniques

IGAP Flap Breast Reconstruction

Inferior Gluteal Artery Perforator Flap

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Although the DIEP and SIEA flaps are generally the first choice for perforator-flap breast reconstruction, not all women are candidates for a perforator flap harvested from the abdomen. In addition, some women may simply prefer to have a reconstruction using a donor site other than the abdomen. Some extremely slender women may have too little abdominal tissue to reconstruct a breast of the desired size, while others may have previously undergone specific abdominal surgery that precludes the use of an abdominal perforator flap (for example, a tummy tuck). The gluteal artery perforator flaps or GAP flaps are one of the commonly employed alternate perforator flaps used in breast reconstruction. As is the case with the DIEP flap, muscle is left in place at the donor site to preserve function and make recovery easier.

The Buttock as a Donor Site

With GAP flaps, tissue for breast reconstruction can be harvested from either the upper or lower buttock, depending upon body shape and personal preference. Skin and soft tissue can be harvested from the buttock region using an incision that will be concealed in most clothing, possibly even in some bikinis. The blood vessels needed for a GAP flap are meticulously separated from the gluteus maximus muscles in which they travel without removing any muscle.

• SGAP Flap (upper buttock):
  The superior gluteal artery is employed when the upper buttock tissue is used for the reconstruction. When the very upper most buttock tissue along with excess hip tissue is used, the flap is sometimes called a Hip Flap.
• IGAP Flap (lower buttock):
  The inferior gluteal artery supplies the skin and fat of the lower buttock and nourishes the inferior gluteal artery perforator or IGAP flap. The IGAP flap is harvested from the lower buttock. The scar that results from harvest of this flap is designed to lie within the natural lower buttock crease.

Muscle Preserving Surgery

The blood vessels that are incorporated into an IGAP or SGAP flap are connected to blood vessels at the mastectomy site using microsurgical techniques. After the blood vessels of the flap are connected, a GAP flap is shaped into a new breast.

Optimizing Aesthetics

As with other flaps, approximately three months after the initial stage of breast reconstruction surgery, reconstruction of your nipples (when mastectomy includes their removal), refinement of breast shape and procedures to produce symmetry with your untreated breast can be completed. These optional additional procedures are performed on an outpatient basis and are referred to as Stage II.

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IGAP Flap Surgery in New York and Connecticut

Contact us if you would like more information about IGAP flaps for breast reconstruction or if you would like information about other options for breast reconstruction after mastectomy including DIEP and TUG flaps. Our practice has offices in New York City and Greenwich, Connecticut.